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Huge lesion : purulent drainage
From: Mark Dreyer
To: ROOTS
Sent: Saturday, July 26, 2008 2:05 AM
Subject: [roots] Huge lesion
I tx planned this case a year ago. The guy didn't schedule for tx until
a month ago when his face was swollen like a balloon. Initial visit we
did the cleaning shaping, noted tons of purulent drainage. Also did I&D
and got another ton of drainage. Today all swelling and symptoms had
resolved so we packed the case. There were no obvious signs of fx nor
any probing defects so I'm quite optimistic this will heal and look
forward to hopefully getting him back for recalls.
I know some endodontists don't pack a case like this till they see
radiographic evidence of healing 3-6 months later. I can see the value
of this if the tooth was a critical abutment for a multi unit bridge
for instance, (not wanting the gp to go ahead with an expensive
restorative plan utilizing a tooth like this until it looks like things
are healing) but in a single tooth situation like this, especially with
a patient that has demonstrated a previous lack of compliance with tx
recommendations, I think it's best to get the case finished asap.
-- Mark Dreyer
I see your wisdom Dr Mark. Better to have the RCfill before the patient
does another disappearing act. I follow the same protocol. Risky, but
compared to the risk of the patient disappearing with your temp and
turning up with a bigger mess, I choose the risk of doing the RCFills
on my lazy patients on the same day - Sanjay
Sanjay, I probably should have just taken the bull by the horns and done
the buildup also because of the same rationale, but I've found doing that
sort of thing doesn't set well with referring docs, and I still have two
expensive teenagers to support. :-)) - Mark
Mark, After thorough debridement and disinfection, root filling after a
few weeks is appropriate. Waiting 12 weeks to see some healing is
beneficial in the long run, IMHO, for long-term treatment planning.
Nice case! - Fred
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